Owensboro Rifle & Pistol Club, Inc.

Application for Membership

Membership DUES are $30 per year and run April 1 through March 31.

Name__________________________________________________________________


Address_______________________________________________________________


City, State, Zip_______________________________________________________


Email_______________________________ NRA number____________________


Date of Birth_____________________


Home Ph. Number____________________ Work Ph. Number___________________


Have you ever been convicted of a crime YES / NO
Have you ever had your right to own or register a firearm suspended YES / NO

Write full details if you answered yes to either question above

I hereby certify that the information I have provided on this form is true and accurate to the best of my belief and knowledge:

Signature______________________________________________Date_____________

Print and mail the completed application form with payment to:

ORPCI
c/o Gary Welborn
520 Fate Lutz Road
Hanson, KY 42413